Tag Archives: Healing

Every night leaving work, it’s like the energizer bunny coming to screeching halt after a nonstop day of go-go-go.. On autopilot, I resist collapsing like one big gelatinous noodle. In some recess of my brain I know that my bed is better than train tunnel for sleeping. Thus far, I have always won against my limbs, thank god. Not that I am actually complaining. This is exactly what I wished for: bedside nursing, interacting with people as much as possible, constant learning, and never sitting at a desk in a cubicle. I got all of those things. So far, no matter how tired, frustrated or emotionally drained I am at the end of a hard day in the ER, I am still excited to go back (after a solid night of rest). I can’t say how long this honeymoon phase of our relationship will last (me and the ER, that is) but I am really hoping it’s a not a fleeting feeling.

As a new nurse, I am always running, my brain whirring, trying to anticipate the next step. In the beginning, I had plenty of time to learn my patients and know them fairly well (at least well for a brief ER interaction) but now as I grow more adept with my few patients, I have been taking on more patients, and more. It’s hard to know them as well now, often, just staying on top of their medical case is the best I can manage. Sometimes I yearn to spend more time with just a few patients…respond to all their “real” needs as well as the self-professed “real” needs, instead of triaging their professed needs myself. (For example, bleeding wound=real need. Fix it: clean, gauze, tape, presto-donezo. While, “I’m starving, I haven’t eaten in 18 hours, get me some food now,” is not a real need…I am sorry but it’s not, when the guy in the next bed is bleeding.) I want to respond to all needs equally, which is simply impossible in the ER. I have to make snap decisions, which clearly doesn’t please everyone. The flip side of wishing that I only had a few patients, is that obviously there are some patients that you would much prefer never even crossed the threshold… Luckily, there haven’t been many of those.

Sometimes it’s impossible to miss a special moment though. Yesterday, I had an elderly patient with a laundry list of geriatric problems — Alzheimer’s, Parkinson’s, new onset seizures, the works. Oh yeah, and probable pneumonia on admission. The wife (who looked much better, I might add, and at least 10 well-preserved years younger) claimed that her husband, on a better day (pre-pneumonia, I imagine) walked around the house a little bit, and even spoke occasionally. Pretty incredible to believe from what I saw lying on the stretcher. Nonverbal, limbs contracted inwards, shivering and weakened by illness, he was a full workup waiting to happen. He was in my care all day, while being screened into the ICU and then waiting for a bed to become available. While we drew labs, waited for results, started broad-spectrum antibiotics and gentle fluids, and periodically changed his sweat-soaked sheets, I watched the wife interact with her feeble and febrile husband. He never spoke, but she spoke to him and seemed very certain of what he needed at any given moment. She, dressed in a smart red suit with perfectly arranged hair, sat at his bedside for hours upon hours. And this is no private room either. The ER is full of incessant beeps, whistles and alarms, combined with a cacophony of human-emitted noise – complaints, moans, the works. It can’t be pleasant for a patient or a family member (not that I particularly care for it, either). Yet, she calmly and gracefully sat by his side and thanked us for all the care we provided, not once blaming us for the slow pace of diagnosis and admission to the ICU. At regular intervals when I checked on him, she would be stroking his forehead whispering gently to him, or rearranging his pillows and blankets, or spoon-feeding him miniature bites of applesauce. It nearly brought tears to my eyes, such tender and private interactions that I witnessed as my patient’s nurse. These are the moments that I live for and that I strive to reproduce as a nurse for my patients that have no one at bedside. If this patient had been all alone, I might not have known a single thing about him other than the details of his illness. But with his wife at bedside, I learned that he had someone who loved him dearly, and he probably loved just as tremendously in return. Learning these little tidbits reminds me that my patient is also a person, with a story all his own beyond the hospital stretcher. On a busy day, there isn’t often time to find out the stories of every individual, but it’s important to remember that they all have one.

Sorry for the lame-O photO today...rushing around this morning and had to use my phone camera for the snapshot.

Mmmm, I made the most delicious and nutritious muffins yesterday. Truly! The word muffin is not usually synonymous with nutritious (even if it poses as nutritive) but this is actually factually a yummy-tasting specimen. It doesn’t even taste like cardboard, as my mother suspiciously asked me today, point-blank, as I gushed about them. Rightly so, she is suspicious of replacing butter and other deliciously decadent fats with healthier alternatives like applesauce, and for the most part, she is right. Nothing stands up to butter and fat in the taste category. But if you are looking for something that won’t necessarily compete, but simply serve as a humble and healthy alternative, then this is it. And it won’t even make you muffin-top over those nice new pants you just purchased. Unless you eat 20 of them. Bah ha ha.

In a large bowl, combine flours, sugar, cinnamon, baking powder, baking soda and salt. Stir in carrots, apples, coconut and walnuts mixture. Stir in wet ingredient mixture until just moistened. Spoon the batter into the prepared muffin cups, filling them about 3/4 full.

Bake at 375 degrees F (190 degrees C) for 15 to 20 minutes, or until the tops are golden and spring back when lightly pressed. (I had to bake them much longer, roughly 25-30 min – test the centers!)

Well, I am already behind on my pledge to document this ER experience. Little did I know just how draining 12-15 hour shifts can be. Especially as a nursing student fresh off the press, I almost feel like I am being thrown to the wolves every morning at 7am when I walk onto the floor. Luckily, (most of the time) I have a very protective preceptor who keeps me close under her wing, but it’s still a lot to take in for a newbie.

Today the trauma room saw its fair share of blood, gore and more. And I saw far more than my typical allotment. First a man came in who had fallen from a 30-story building. That didn’t last long. While in my freshness I was very much distracted by the nearly-severed foot jutting out from a protruding tibia and fibula and a matching skull flap, the internal injuries were the real outcome-predictor. Seasoned nurses told me that shearing forces can cause the entire aorta to rupture. I only spent a few moments in the trauma bay on that case, but it was more than enough time to be imprinted in my memory. The second case was more hopeful. A middle-aged man came in to the ER already in cardiac arrest with CPR in progress. Lost in the hubbub of the moment was a warning from a veteran RN for us NOT to cut off the man’s down jacket. But once the presiding resident made the call, all hands were on board cutting off and removing clothing at lightning speed. Soon there were downy feathers snowing down and nestling in every crevice. In an already chaotic scene, the sight of the feathers made it even more absurd. I served as the scribe, which was an excellent way to follow the rapid-fire succession of events. From no pulse and asystole, this man was successfully revived and stabilized with a v-tach rhythm before he was quickly shipped off to the cath lab. This was a much better outcome to be a part of. Minus the bird feathers and blood that tarred the floor at the end of the code…

One sad event that really stuck with me and I need to unload before going to sleep. We discharged a young woman who came in for seizures. Since we weren’t on her team prior to discharge, we asked for a brief history. She said that she fell down a flight of stairs during the seizure. My preceptor asked if she hit her head on the way down and the patient nodded, like it was obvious. She asked how she got help and who found her, and this poor young lady said, “What do you mean, who found me?” I took care of myself.”

My preceptor tried to clarify, and asked, “Oh, ok, but who called the ambulance?”

She responded simply, “I got myself up, and called it myself.”

For some reason that really sounded sad to me, and more so when my preceptor asked how she was getting home. She had no one to come pick her up and she didn’t feel safe going to the subway because of all the stairs, and her discomfort around trains. Even though she lived less that 2 miles from the hospital, she barely knew the bus lines. Taking her out to discharge, I glanced through the glass exit doors to see a dusky sky, quickly turning black. My sadness for her was almost overwhelming. No one should both come to the ER and leave completely alone, yet too often this is what happens.

Let’s leave this entry on a funnier note. My first patient of the day was a loud old blind man with an Albert Einstein-esque hairdo, who compensates for his lack of sight by screaming all the time. Anytime a shadow of a person walked by his room, he would yell, “NURSE, NURSE! CAN I GO HOME YET?” When asked to lower his voice by my sweet and mouse-like preceptor, he would yell, “I CAN’T HEAR YOU! WHY DO YOU TALK SO QUIET?” She would reply, obviously bothered by his loud volume, “Why do you talk so loud?”

“I STILL CAN’T HEAR YOU! WHEN AM I GOING HOME?”

“Sir!” Finally reaching to the top of her internal volume modulator, my preceptor gathers all her strength and yells back, “We can’t send you home until we have your lab results. Sir, we are getting them as soon as we can!”

“OH OK! FINE, WELL WHY DIDN’T YOU SAY SO?” Exasperated, my preceptor escapes the room. Thinking it’s over, I go onto the next patient, but it’s not two minutes later that I hear him again, “NURSE, NURSE, I AM READY TO GO HOME. CAN I GO HOME NOW?”

I don’t know why this was so funny, but somehow it was, and we were all laughing. In an ER, where things are so emergent and tense for so many people, sometimes you just need to take things a little more lightly and help others see the small humor in daily things as well. I find that I say cheesier jokes in the ER, and brace myself, expecting a courtesy grimace at most, but I actually get more laughs there than I do at any better jokes that I ever crack outside of the ER. Happiness is a hot commodity in the ER and it’s in demand. I like this work because no matter what, I always find reasons to smile.

In the wake a devastating tsunami, the nuclear reactor disaster and all the events that have succeeded the earthquake in Japan, it seems somehow appropriate that I begin my integration period tomorrow in the Emergency Room of a bustling metropolitan hospital. When I told the director of my program that I was very interested in Emergency Preparedness as a subspeciality, I had no idea that she would take my interest so seriously and give me an eight-week ER clinical placement. I feel so lucky, and also SO nervous. I am going to try to document this experience, as I work eight weeks under the tutelage and supervision of a RN. I will be taking her normal hours which means 12-hours shifts for a total of 36 hours per week, for 8 weeks.

In my anxiety-flavored preoccupation over what tomorrow will hold, I called my grandfather, for some sage words of advice. In typical fashion, he proffered a few more that I initially asked for, but absolutely helped to assuage my fears. When I told him I was afraid, he reminded me that it was normal to feel scared in a setting where everyone is having personal crises. Nerves run high, but he told me that among emergency personnel, calmness and composure are paramount. He reminded me that people work together in the ED like a well-oiled machine, and that I will never feel stranded. I hope this last part is true. He also told me something that I know: I will feel uncomfortable. I will not feel proficient. I will make mistakes. But then, I will ask questions and I will learn from these mistakes. If I don’t ask a question when I have one, that is the biggest mistake I can make. This is my time for learning, and I will learn.

He also told me that he knows I will be calm in the face of a crisis. I don’t know how he can be sure of this, since I am certainly not sure of myself, but then he told me about the night when my grandma took his own hypertension medication accidentally, and how terrified he felt. In response, he called his cardiologist at home (ah, the benefits of having doctor colleagues) who told him that he could manage the situation on his own, rather than bring her into the ED so late at night. So, my grandpa pushed his fear back and kept it at bay throughout the night while he stayed awake and cared for the love of his life. He told me that he fed her so much coffee, that by the morning he had induced hypertension in my grandma. Not exactly the most settling story for a granddaughter to hear, but very sweet all the same especially since the outcome was good.

My goal for these few weeks is to chronicle my experience, writing down the wisdom of veteran nurses for my future practice as well as the more fun and interesting cases that I run into. Now I just have to wait a few more hours to see what tomorrow has in store…

Small bowel transplant went without a hitch according to the surgeons. They called it a “perfect fit.” For some reason I had a terrible feeling in the pit of my stomach all throughout it… But, for once, I know I was wrong to trust my gut. This young woman is one of the strongest people I know. Today, barely 24 hours later, from the ICU I actually spoke to her on the phone. She is awake, and sounds amazing. Her physical therapist helped her get OUT OF BED. I haven’t ever heard of anyone sitting up in an ICU, much less moving to a chair! Her strength is phenomenal; I have goosebumps as I write this. I will be next to her Friday evening, and I am so grateful that I can be there.

Other news: I helped a woman breastfeed for the first time today. It was the most amazing, beautiful and healing experience ever. OB is like respite care for nursing students. I wish I could take it like ibuprofen for headaches.

I don’t even know where to begin. I feel like my brain has been rolled through a paper shredder on high speed with a magazine mixed in for confusion.

Last night I got the news that one of my close friends got the phone call she has been waiting for. However, this is not the type of call that any healthy 23-year young woman should be waiting for. She has been waiting for a small bowel transplant after having gastric bypass surgery just over a year ago, losing well over a hundred pounds and nearly reaching her ideal body weight through a combination of healthier living and exercise. Then, severe and sharp pains to her abdominal region complicated her course. Her gallbladder and 26 gallstones were removed, which unfortunately didn’t go far to solve any problems. Without writing a novel, or giving away any personal information, it was soon discovered that nearly her entire intestinal tract was rotten.

Suffice to say, her outcome was poor to dreadful. But through a combination of incredible strength, excellent medical care and a whole lot of love, support and luck, she somehow stabilized after having her entire bowel removed, save a few inches on either end. She was stable, but certainly not out of the woods. To say nothing of the struggle with insurance or malpractice suits, her life has been blown to smithereens for the past 5 months, and it is only recently that she was finally cleared for transplant. And yesterday she got the call.

The organ was in the Midwest, so at 3am, a team went out to harvest it. I was in contact with her via a few brief phone calls and a piddling of texts. She is on edge, and I am on pins and needles – I can only imagine how much more difficult it is for her. She is so incredibly strong, yet how much can a person really take? While in my afternoon classes, I got news that she was being taken in. The transplant would go forward: the organ was viable. After clinic this evening, I got a text from her mom. About an hour ago, the bowel had been successfully placed and she was stable. She would still be in the OR for a few more hours. So that’s one piece, the most important piece, of this whirlwind that is stealing my breath and messing with my mind. But it’s not all.

I have recently started volunteering with a Harm Reduction Clinic and needle exchange. Initially, the idea was to participate with the student-run clinic, which operates every other week, on one weekday evening. But more recently we have been working closely with the program coordinator and toying with the idea of starting a program that offers services strictly to their female participants. These participants are sex workers, IV drug users, or both. The idea is to offer a support group, maybe some case management, definitely health education, and hopefully women’s health services and point-of-care testing. This is all still a nascent dream, but it has already gotten minimally underway with a survey tool that we have developed to use in conjunction with a focus group. More on that to come.

Today we spent time at the needle exchange in the morning and the evening just to start getting to know a few of the participants and the general “flow.” The morning was mellow and this evening we were able to watch and observe the clinic in action. I shadowed a medical student with a patient who we’ll call Arnie.* Obviously it would be crazy to claim that I didn’t have a single stereotype or preconceived notion of what a (past) drug user, current panhandler and intermittently homeless man would be like. And being myself, I at least give myself credit for expecting and seeing these incorrect assumptions disproved within seconds.

This was a fairly well educated man with typical but exacerbated health problems: many of which that he understood far better than your typical layperson. Better than me, in fact, in some cases. He was agitated when he sat down, and rightly so. He felt like he was being seen by a medical student and a nursing student and he wanted to see the real doctor right away. He asked smart questions and he made a lucid point about unequal medical care, comparing his own care to that of former Mayor Giuliani’s daughter’s care. I had to agree that they didn’t quite match up. Then we got down to business. I was at once impressed by the second year med student’s knowledge and overwhelmed by my vast lack of knowledge. But I have to remind myself that knowledge isn’t a secret elixir-I will attain it too, someday, and at least my social skills are intact.

Arnie and I made a connection. I recognized it, and I think he did too. In trying to compliment me at the end of the history-taking, he told me that I should really go to med school too because I would make a better doctor. I could have hotly informed him all about nursing and why I chose it as my profession instead but….Argh, sigh. We’ll tackle that topic another day.

(Reflecting on how astute and intelligent I found him to be, I do want to mention that in one of his many rants, he speculated on how silly it was that doctors didn’t have to become nurses first. He said that nurses do all the work, they provide the majority of the hands on care, and they are the most well informed individuals in firsthand experience and that they should be the ones to go onto med school and become the best doctors one day. His words, not mine. I swear.)

His problems aren’t insurmountable, but they did seem enormous to me tonight. It wasn’t the diabetes, the infection, the mysterious skin condition, or even the coronary artery disease. It wasn’t the arthritis or the peripheral neuropathy. It was more the fact that he was in a downward spiral and unlikely to climb his way out, despite our best effort. This really put a story to the faces that I see in the subway. The panhandlers, the singers, the dancers, the vendors. They all work in this gray market – one that isn’t very visible but very much exists. Arnie is an a cappella singer. I heard his baritone when he opened his mouth for us to examine his throat. I got a vivid image of one day seeing him on the subway in my daily commute. It’s not unlikely. It made me squirm and feel desperately sad for a moment.

When I left that evening, late, well past 10pm, I sighed when I looked outside and saw pouring rain. I turned back inside and mentioned to one of the clinic’s participants that it was raining. “Bummer,” I said. And she looked at me and said, “Yeah, that really is. That just about ruins my night.” I sucked in a breath. It was too true. And it hit me hard. Our program coordinator told me that volunteers here hope to get their “feet wet” in the complex world of harm reduction. But she said she always laughs a little bit inside, because the reality is, that if you really want to help, you’re not going to just get wet. You’ll get soaked.

So, saying goodnight, I jogged out into the rain without another self-pitying thought. I took the subway. And then I biked home from the train station, barely even glancing at the tempting taxis. I got soaked, and as melodramatic as it might sound, it felt right.

And first a story that is good for my non-New Yorker soul. This story renews my desire to make peace with the fast pace of Manhattan, the rats in the subway rails, and the lack of recycling or composting.

On Wednesday, I was going to my community clinical. This is one of the only rotations this year that I get to shuck my scrubs and don lovely business casual clothes instead. I really don’t mind leaving my white granny shoes and compression socks at home, really, truly I don’t. Not that I hate the scrubs; they are pretty comfy, as far as polyester goes. But in the classy clinic that I am in for this rotation, I like my classy clothes.

But anyways, that’s not the point of this story. To go with my clinic clothes, I was carrying a purse instead of my school backpack. I had transferred everything I needed for the day into the purse, or so I thought. I even squeezed in a lunch.

I took the train into the city, and then skipped down to the bowels of the city. I swiped my unlimited metro card, very professionally. I am becoming an expert swiper, mind you. Nothing. I swiped again to be sure. Yep, time for a new card. So I went to a machine, which digging deep into my cavernous purse for my wallet. Then my heart sank, and I realized – no wallet. I brought everything except my wallet. Happens to the best of us. The scenarios that ran through my head in the next few seconds were not pretty. I saw myself holding a Styrofoam cup out for change, crumpled defeated in the corner of the station. Then I saw myself being turned down by 20 people, becoming increasingly more agitated and teary as I was rejected again and again for a swipe or a meager $2.25. For about 20 seconds, I could taste my fear, and it was not tasty. But there was no other option. I would have to ask the scary New Yorkers for cash.

I turned around, steeling myself, and almost ran headlong into the person directly behind me. Oh yeah. I forgot that I was at a subway ticket kiosk, holding up people behind my with my frantic wallet search. He looked like a relatively nice guy – business suit, no eye stink eye. All good characteristics that made him semi-approachable. So I bumbled and blubbered my way through my story, and before I could even finish, he was already reaching for his wallet. Seriously! Relief washed over me, as I realized that I would not be in the subway station all day. Nay, not even two minutes extra. It was nearly painless, actually! Probably even more pleasant than it would be in Seattle (ok, maybe that is stretching it).

But, really, why do I think all New Yorkers are evil and mean? I guess it’s because walking down the street, they don’t automatically smile and greet me. Thankfully for this experience, I have now decided that it is not good enough evidence to pass such harsh judgment. I have now become one of the individuals on the subway that New Yorkers have shown compassion for, enough to reach deep into their pockets for some spare change. I see it happen here more than anywhere else I have been in the world. So, I ask myself: should the new definition of a New Yorker be the Good Samaritan? Maybe I am pushing it too far, but still…food for thought.

What to do:
Saute onions, garlic and carrots in a little olive oil. After they begin to brown, add vegetable stock. Peel and chop sweet potato and butternut squash into large pieces. Add to stock and cook until tender. Puree soup and return to stove. Season with salt, pepper, and cayenne and then top with generous amounts of shaved Classic Chile Chocolate. Enjoy.

Toss all of the above listed ingredients together on a baking tray. You can sprinkle the cheese on last, if you choose. Bake at 400 degrees until toasty brown. The sage and salt make it nearly unnecessary to season the soup itself. Hearty goodness.